<!DOCTYPE">
<html xmlns="">

	<head>
		<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
		<meta name="viewport" content="width=device-width, initial-scale=1,maximum-scale=1, user-scalable=no">
		<meta name="apple-mobile-web-app-capable" content="yes">
		<meta name="apple-mobile-web-app-status-bar-style" content="black">
		<title>分销商申请单</title>

		<link rel="stylesheet" type="text/css" href="../css/css.css" />
		<link rel="stylesheet" type="text/css" href="../css/iconfont.css" />
		<script type="text/javascript" src="../js/jquery.min.js"></script>
		<script src="../js/common.js" type="text/javascript" charset="utf-8"></script>
	</head>

	<body>
		<div class="main">
			<header class="header">

				<div class="title">
					设置分销商
				</div>
				<div class="backHome">
					<a href="">
						<i class="icon iconfont icon-shouye"></i>
					</a>
				</div>
			</header>
			<div class="user">
			<div class="left">
				<img src="../img/userImg.png" />
			</div>
			<div class="right">
					<p class="font16">李三</p><br />
					<p class="font16">151****1234</p>
			</div>
		</div>
		<div class="form">
			<ul>
				<li class="input">
					<p>电话</p>
					<input class="right" type="text" placeholder="15312345678" />
				</li>
				<li class="input">
					<p>真实姓名</p>
					<input class="right" type="text" placeholder="李三" />
				</li>
				<li class="input">
					<p>身份证</p>
					<input class="right" type="text" placeholder="" />
				</li>
				<li class="input">
					<p>性别</p>
					<input class="right" type="text" placeholder="保密" />
				</li>
				<li class="input">
					<p>出生日期</p>
					<input class="right" type="text" placeholder="" />
				</li>
				<li class="input">
					<p>地址</p>
					<input class="right" type="text" placeholder="安徽省芜湖市镜湖区" />
				</li>
			</ul>
		</div>
		<input type="button" class="fullButton" value="设置为分销商" />
		
		</div>
		<ul class="footBar">
			<a class="btn greenbg">
					<i class="icon iconfont icon-fenxiang marginRight"></i> 扫描
			</a>
		</ul>

	</body>

</html>